Perspectives for the longer term: meeting expectations
Prof. Wulf Rössler
Psychiatrische Universitatsklinik,
Zurich, Switzerland, Presenter

The goal of community psychiatric services is to promote integration of psychiatric patients back into society, and to help patients live their lives as normally and as voluntarily as possible. Combining atypical antipsychotic pharmacotherapy with psychosocial interventions may help serve that goal in the long-term treatment of schizophrenia.

Determing optimal long-term treatment of schizophrenia requires assessment of adequate outcome measures. Previous studies have assessed symptom improvement and drug adverse effects, but have under-emphasized patients' well-being and long-term prospects. The following should be included among outcome measures in long-term treatment: psychopathology, cognitive function, interpersonal/social function, work/school function, independent living, quality of life, compliance, side effects, hospitalization, family burden, and cost.

One of the factors affecting patients' quality of life is the support from family members and therapists. However, this is difficult to assess because family members, as main caregivers, often suffer from disturbed relationships with the patients, and therapists tend to judge the patients more harshly than the patients do themselves. Therapists, to better understand their patients' subjective views, should change weighting components of their assessment, e.g., reducing the importance of psychopathology and addictive behavior, and increasing the importance of leisure activities.

In the long-term treatment, not only control of symptoms, but enhancement of patients' quality of life is important. Thus, psychosocial interventions should be combined with pharmacotherapy, consistent with studies reporting larger effect sizes in patients treated with both compared with patients treated with either alone.

Some studies have reported that atypical antipsychotics may be more effective than conventional agents in improving psychotic symptoms, enhancing cognitive functioning, and reducing rehospitalization and relapse rates. Atypical antipsychotics also have been associated with lower rates of adverse effects. Interestingly, some studies have reported that European psychiatrists would choose an atypical antipsychotic over a conventional agent for a family member.

Table
Usefulness of atypical antipsychotic drugs

 ・Reduction in various psychiatric symptoms
 ・Enhanced cognitive function
 ・Improved side effect profile
 ・Improvement in long-term symptom control
 ・Reduction in re-hospitalization and relapse rates

In summary, optimal outcome in schizophrenia may depend upon combining atypical antipsychotics with psychosocial interventions.

Reporter: Takeshi Terao, M.D.

 

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